Migraine Care Often Subpar for Uninsured, Medicaid Patients

Standard therapy often not received at emergency rooms, where many of these patients seek care

By Jeff Muise

HealthDay Reporter

TUESDAY, April 13 (HealthDay News) -- Uninsured people and those on Medicaid who suffer from migraines are more likely to receive substandard therapy than privately insured patients, at least partly because they receive more care in the emergency department instead of a physician's office, according to research published in the April 13 issue of Neurology.

Andrew Wilper, M.D., of the Boise VA Medical Center in Idaho, and colleagues assembled data for 1997 to 2007 from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey on patient visits to U.S. physicians, hospital outpatient departments and emergency departments. The researchers analyzed the data to determine if there was an association between insurance status of the patient and whether or not they received standard care, defined as triptan or dihydroergotamine and a prophylactic agent.

The researchers identified 6,814 patient visits for migraine, with the uninsured and Medicaid patients disproportionately using emergency departments for care. After adjusting for age, gender, race and other factors, the patients without insurance or with Medicaid were less likely than privately insured patients to receive abortive therapy (odds ratios [ORs] for failure to receive medication, 2.0 and 1.6, respectively) and prophylactic therapy (ORs, 2.0 and 1.5, respectively). Treatment in an emergency department, as opposed to a physician's office, also was associated with failure to get standard care (OR, 4.8 relative).

"Using the prescription of triptan or dihydroergotamine or the prescription of a prophylactic agent as proxies for standard care of migraine headache, we have found that the uninsured are twice as likely as the privately insured to receive substandard migraine care. Migraineurs insured by Medicaid are also more likely to receive substandard care," the authors write.